Minimally Invasive Fully Endoscopic Dynamic Four-Hands Surgical Technique (MInDFul) for Anatomy-Guided Management of Intracranial Lesions: Technical Note and Monocentric Case Series.

Abstract

Minimally invasive neurosurgery is increasingly expanding due to advancements in intraoperative technologies. The use of surgical endoscope is usually combined with microscope to approach intracranial lesions. In this study, we introduce a fully endoscopic minimally invasive surgical technique (MInDFul), that provides continuous high-definition dynamic visualization, giving an analysis of its distinctive characteristics, advantages, and applications in the management of intra- and extra-axial, ventricular, and vascular lesions. We present a monocentric case series conducted in accordance with the PROCESS guidelines, detailing the MInDFul technique and analyzing clinical, surgical, and histopathological data from patients treated in 4 years. For each surgical approach, we assessed operative duration, clinical outcomes, complications, and postoperative imaging to evaluate surgical success. Fifty patients (mean age 53.3 ± 14.9 years) with intracranial lesions underwent MInDFul surgery using 8 different approaches. The mean operative time was 182 ± 85 minutes, achieving gross total resection in 23 patients (46%), and subtotal in 13 (26%). Only 5 patients (10%) required post-operative admission in ICU. Postoperative Karnofsky Performance Status significantly improved (P< 0.001), remaining stable at the one-month follow-up, where recurrences occurred in 11 patients (22%), with 6 (12%) re-interventions, all involving benign histologies. The MInDFul technique represents a feasible fully endoscopic strategy for the management of selected intracranial lesions, providing dynamic visualization and minimal brain retraction. In this series, the technique was associated with good surgical and functional outcomes. Comparative studies will be required to determine its potential advantages over standard microscopic approaches.